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Light therapy for seasonal affective disorder in visual impairment and blindness – a pilot study

Published online by Cambridge University Press:  04 March 2021

Helle Østergaard Madsen Open the ORCID record for Helle Østergaard Madsen [Opens in a new window] ,
Shakoor Ba-Ali ,
Ida Hageman ,
Henrik Lund-Andersen  and
Klaus Martiny Open the ORCID record for Klaus Martiny [Opens in a new window]
Helle Østergaard Madsen*
Affiliation:
Mental Health Centre Copenhagen, Copenhagen, Denmark
Shakoor Ba-Ali
Affiliation:
Department of Ophthalmology, Rigshospitalet-Glostrup Hospital, Copenhagen, Denmark
Ida Hageman
Affiliation:
Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
Henrik Lund-Andersen
Affiliation:
Department of Ophthalmology, Rigshospitalet-Glostrup Hospital, Copenhagen, Denmark
Klaus Martiny
Affiliation:
Mental Health Centre Copenhagen, Copenhagen, Denmark
*
Author for correspondence: Helle Østergaard Madsen, E-mail: [email protected]
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Abstract

Objective:

Seasonal and non-seasonal depression are prevalent conditions in visual impairment (VI). We assessed the effects and side effects of light therapy in persons with severe VI/blindness who experienced recurrent depressive symptoms in winter corresponding to seasonal affective disorder (SAD) or subsyndromal SAD (sSAD).

Results:

We included 18 persons (11 with severe VI, 3 with light perception and 4 with no light perception) who met screening criteria for sSAD/SAD in a single-arm, assessor-blinded trial of 6 weeks light therapy. In the 12 persons who completed the 6 weeks of treatment, the post-treatment depression score was reduced (p < 0.001), and subjective wellbeing (p = 0.01) and sleep quality were improved (p = 0.03). In 6/12 participants (50%), the post-treatment depression score was below the cut-off set for remission. In four participants with VI, side effects (glare or transiently altered visual function) led to dropout or exclusion.

Conclusion:

Light therapy was associated with a reduction in depressive symptoms in persons with severe VI/blindness. Eye safety remains a concern in persons with residual sight.

Keywords

seasonal affective disorderdepressionphototherapyblindnessretinal ganglion cells
Type
Original Article
Information
Acta Neuropsychiatrica , Volume 33 , Issue 4 , August 2021 , pp. 191 - 199
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of Scandinavian College of Neuropsychopharmacology

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References

American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders: DSM-5, 5th Edn, Arlington VA: American Psychiatric Association.Google Scholar
Andrews, CD, Foster, RG, Alexander, I, Vasudevan, S, Downes, SM, Heneghan, C and Plüddemann, A (2019) Sleep-wake disturbance related to ocular disease: a systematic review of phase-shifting pharmaceutical therapies. Translational Vision Science and Technology 8(3), 1–11.CrossRefGoogle ScholarPubMed
Auger, RR, Burgess, HJ, Emens, JS, Deriy, LV, Thomas, SM and Sharkey, KM (2015) Clinical practice guideline for the treatment of intrinsic circadian rhythm sleep-wake disorders: advanced Sleep-Wake Phase Disorder (ASWPD), Delayed Sleep-Wake Phase Disorder (DSWPD), Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD), and Irregular Sleep-W. Journal of Clinical Sleep Medicine 11, 1199–1236.CrossRefGoogle Scholar
Bech, P, Wilson, P, Wessel, T, Lunde, M and Fava, M (2009) A validation analysis of two self-reported HAM-D6 versions. Acta Psychiatrica Scandinavica 119, 298–303.CrossRefGoogle ScholarPubMed
Bierings, RAJM, Kuiper, M, Van Berkel, CM, Overkempe, T and Jansonius, NM (2018) Foveal light and dark adaptation in patients with glaucoma and healthy subjects: a case-control study. PLoS ONE 13(3). https://doi.org/10.1371/journal.pone.0193663.CrossRefGoogle ScholarPubMed
Bierings, RAJM, van Sonderen, FLP and Jansonius, NM (2018) Visual complaints of patients with glaucoma and controls under optimal and extreme luminance conditions. Acta Ophthalmologica 96(3), 288–294.CrossRefGoogle ScholarPubMed
Brouwer, A, Nguyen, HT, Snoek, FJ, van Raalte, DH, Beekman, ATF, Moll, AC and Bremmer, MA (2017) Light therapy: is it safe for the eyes? Acta Psychiatrica Scandinavica 136(6), 534–548.CrossRefGoogle ScholarPubMed
Chang, CH, Liu, CY, Chen, SJ and Tsai, HC (2018) Efficacy of light therapy on nonseasonal depression among elderly adults: a systematic review and meta-analysis. Neuropsychiatric Disease and Treatment 14, 3091–3102.CrossRefGoogle ScholarPubMed
Choi, HG, Lee, MJ and Lee, SM (2018) Visual impairment and risk of depression: a longitudinal follow-up study using a national sample cohort. Scientific Reports 8, 2083. doi: 10.1038/s41598-018-20374-5.CrossRefGoogle ScholarPubMed
Court, H, McLean, G, Guthrie, B, Mercer, SW and Smith, DJ (2014) Visual Impairment is associated with physical and mental comorbidities in older adults: a cross-sectional study. BMC Psychiatry 12 (181). doi: 10.1186/s12916-014-0181-7.Google ScholarPubMed
Crowley, SK and Youngstedt, SD (2012) Efficacy of light therapy for perinatal depression: a review. Journal of Physiological Anthropology 31(1). doi: 10.1186/1880-6805-31-15 CrossRefGoogle ScholarPubMed
Czeisler, CA, Shanahan, TL, Klerman, EB, Martens, H, Brotman, DJ, Emens, JS, Klein, T and Rizzo, JF (1995). Suppression of melatonin secretion in some blind patients by exposure to bright light. New England Journal of Medicine 332(1), 6–11.CrossRefGoogle ScholarPubMed
Dimitrova, TD, Reeves, GM, Snitker, S, Lapidus, M, Sleemi, AR, Balis, TG, Manalai, P, Tariq, MM, Cabassa, JA, Karim, NN, Johnson, MA, Langenberg, P, Rohan, KJ, Miller, M, Stiller, JW and Postolache, TT (2017) Prediction of outcome of bright light treatment in patients with seasonal affective disorder: discarding the early response, confirming a higher atypical balance, and uncovering a higher body mass index at baseline as predictors of endpoint outcome. Journal of Affective Disorders 222, 126–132.CrossRefGoogle ScholarPubMed
Eastman, CI, Young, MA, Fogg, LF, Liu, L and Meaden, PM (1998) Bright light treatment of winter depression: a placebo-controlled trial. Archives of General Psychiatry 55(10), 883–889.CrossRefGoogle ScholarPubMed
Fernandez, DC, Fogerson, PM, Lazzerini Ospri, L, Thomsen, MB, Layne, RM, Severin, D, Zhan, J, Singer, JH, Kirkwood, A, Zhao, H, Berson, DM and Hattar, S (2018) Light affects mood and learning through distinct retina-brain pathways. Cell 175, 71–84.CrossRefGoogle ScholarPubMed
Flynn-Evans, EE, Tabandeh, H, Skene, DJ and Lockley, SW (2014) Circadian rhythm disorders and melatonin production in 127 blind women with and without light perception. Journal of Biological Rhythms 29, 215–224.CrossRefGoogle ScholarPubMed
Foster, RG (2020) Sleep, circadian rhythms and health. Interface Focus 10(3). doi: 10.1098/rsfs.2019.0098.CrossRefGoogle ScholarPubMed
Gbyl, K, Østergaard Madsen, H, Dunker Svendsen, S, Petersen, PM, Hageman, I, Volf, C and Martiny, K (2017) Depressed patients hospitalized in southeast-facing rooms are discharged earlier than patients in northwest-facing rooms. Neuropsychobiology 74(4), 193–201.CrossRefGoogle Scholar
Golden, RN, Gaynes, BN, Ekstrom, RD, Hamer, RM, Jacobsen, FM, Suppes, T, Wisner, KL, and Nemeroff, CB (2005) The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence. American Journal of Psychiatry 162(4), 656–662.CrossRefGoogle Scholar
Gordijn, M, Mannetje, D and Meesters, Y (2012) The effects of blue-enriched light treatment compared to standard light treatment in seasonal affective disorder. Journal of Affective Disorders 136, 72–80.CrossRefGoogle ScholarPubMed
Hirakawa, H, Terao, T, Muronaga, M and Ishii, N (2020) Adjunctive bright light therapy for treating bipolar depression: a systematic review and meta-analysis of randomized controlled trials. Brain and Behavior 10(12), e01876. doi: 10.1002/brb3.1876.CrossRefGoogle ScholarPubMed
Hull, JT, Czeisler, CA and Lockley, SW (2018) Suppression of melatonin secretion in totally visually blind people by ocular exposure to white light: clinical characteristics. Ophthalmology 125(8), 1160–1171. doi: 10.1016/j.ophtha.2018.01.036.CrossRefGoogle ScholarPubMed
Jiang, L, Zhang, S, Wang, Y, So, KF, Ren, C and Tao, Q (2020). Efficacy of light therapy for a college student sample with non-seasonal subthreshold depression: an RCT study. Journal of Affective Disorders, 277, 443–449.CrossRefGoogle Scholar
Kardon, R, Anderson, SC, Damarjian, TG, Grace, EM, Stone, E and Kawasaki, A (2009). Chromatic pupil responses. preferential activation of the melanopsin-mediated versus outer photoreceptor-mediated pupil light reflex. Ophthalmology, 116(8), 1564–1573.CrossRefGoogle ScholarPubMed
Kasper, S, Wehr, TA, Bartko, JJ, Gaist, PA and Rosenthal, NE (1989) Epidemiological findings of seasonal changes in mood and behavior. A telephone survey of Montgomery County, Maryland. Archives of General Psychiatry 46, 823–833.Google ScholarPubMed
Lam, R, Teng, MY, Jung, YE, Evans, VC, Gottlieb, JF, Chakrabarty, T, Michalak, EE, Murphy, JK, Yatham, LN and Sit, DK (2020). Light therapy for patients with bipolar depression: systematic review and meta-analysis of randomized controlled trials. Canadian Journal of Psychiatry, 65(5), 290–300.CrossRefGoogle ScholarPubMed
Lee, TM and Chan, CC (1999) Dose-response relationship of phototherapy for seasonal affective disorder: a meta-analysis. Acta Psychiatrica Scandinavica, 99(5), 315–323.CrossRefGoogle ScholarPubMed
Lee, HJ, Rex, KM, Nievergelt, CM, Kelsoe, JR and Kripke, DF (2011) Delayed sleep phase syndrome is related to seasonal affective disorder. Journal of Affective Disorders 133(3), 573–579.CrossRefGoogle ScholarPubMed
Legates, TA, Fernandez, DC and Hattar, S (2014) Light as a central modulator of circadian rhythms, sleep and affect. Nature Reviews Neuroscience 15(7), 443–454. doi: 10.1038/nrn3743.CrossRefGoogle Scholar
Legates, TA, Altimus, CM, Wang, H, Lee, HK, Yang, S, Zhao, H, Kirkwood, A, Singer, JH, Kirkwood, A, Zhao, H, Berson, DM and Hattar, S (2012) Aberrant light directly impairs mood and learning through melanopsin-expressing neurons. Nature 491, 594–598.CrossRefGoogle ScholarPubMed
Leger, D, Guilleminaul, C, Defrance, R, Domont, A and Paillard, M (1999) Prevalence of sleep/wake disorders in persons with blindness. Clinical Science 97 (2), 193–199.CrossRefGoogle ScholarPubMed
Lingjærde, O, Ahlfors, UG, Bech, P, Dencker, SJ and Elgen, K (1987) The UKU side effect rating scale: a new comprehensive rating scale for psychotropic drugs and a cross-sectional study of side effects in neuroleptic-treated patients. Acta Psychiatrica Scandinavica 76, 1–100.CrossRefGoogle Scholar
Lockley, SW, Skene, DJ, Arendt, J, Tabandeh, H, Bird, AC and Defrance, R (1997) Relationship between melatonin rhythms and visual loss in the blind. Journal of Clinical Endocrinology and Metabolism 82(11), 3763–3770.Google ScholarPubMed
Lucas, RJ, Peirson, SN, Berson, DM, Brown, TM, Cooper, HM, Czeisler, CA, Figueiro, MG, Gamlin, PD, Lockley, SW, O’Hagan, JB, Price, LL, Provencio, I, Skene, DJ and Brainard, GC (2014). Measuring and using light in the melanopsin age. Trends in Neurosciences 37(1), 1–9.CrossRefGoogle ScholarPubMed
Madsen, HS, Dam, H and Hageman, I (2016) High prevalence of seasonal affective disorder among persons with severe visual impairment. British Journal of Psychiatry 208(1), 56–61.CrossRefGoogle ScholarPubMed
Magnusson, A (1996) Validation of the Seasonal Pattern Assessment Questionnaire (SPAQ). Journal of Affective Disorders 40(3), 121–129.CrossRefGoogle Scholar
Martiny, K, Lunde, M, Simonsen, C, Clemmensen, L, Poulsen, DL, Solstad, K and Bech, P (2004) Relapse prevention by citalopram in SAD patients responding to 1 week of light therapy. A placebo-controlled study. Acta Psychiatrica Scandinavica 109(3), 230–234.CrossRefGoogle ScholarPubMed
Meesters, Y and Gordijn, MCM (2016). Seasonal affective disorder, winter type: current insights and treatment options. Psychology Research and Behavior Management 9, 317–327.CrossRefGoogle ScholarPubMed
Meesters, Y, Winthorst, WH, Duijzer, WB and Hommes, V (2016) The effects of low-intensity narrow-band blue-light treatment compared to bright white-light treatment in sub-syndromal seasonal affective disorder. BMC Psychiatry 16(1), 1–10.CrossRefGoogle ScholarPubMed
van Maanen, A, Meijer, AM, van der Heijden, KB and Oort, FJ (2016) The effects of light therapy on sleep problems: A systematic review and meta-analysis. Sleep Medicine Reviews 29, 52–62.CrossRefGoogle ScholarPubMed
Ospri, LL, Prusky, G and Hattar, S (2017) Mood, the circadian system, and melanopsin retinal ganglion cells. Annual Review of Neuroscience 40(1), 539–556.CrossRefGoogle Scholar
Partonen, T, Vakkuri, O and Lamberg-Allardt, C (1995). Effects of exposure to morning bright light in the blind and sighted controls. Clinical Physiology 15(6), 637–646.CrossRefGoogle ScholarPubMed
Paskowitz, DM, LaVail, MM and Duncan, JL (2006) Light and inherited retinal degeneration. British Journal of Ophthalmology 90(8), 1060–1066.CrossRefGoogle ScholarPubMed
Penders, TM, Stanciu, CN, Schoemann, AM, Ninan, PT, Bloch, R and Saeed, SA (2016) Bright light therapy as augmentation of pharmacotherapy for treatment of depression: a systematic review and meta-analysis. Primary Care Companion to the Journal of Clinical Psychiatry 18 (5). doi: 10.4088/PCC.15r01906.Google ScholarPubMed
Perera, S, Eisen, R, Bhatt, M, Bhatnagar, N, de Souza, R, Thabane, L and Samaan, Z (2016) Light therapy for non-seasonal depression: systematic review and meta-analysis. BJPsych Open 2(2), 116–126.CrossRefGoogle ScholarPubMed
Pjrek, E, Friedrich, ME, Cambioli, L, Dold, M, Jäger, F, Komorowski, A, Lanzenberger, R, Kasper, S and Winkler, D (2020) The efficacy of light therapy in the treatment of seasonal affective disorder: a meta-analysis of randomized controlled trials. Psychotherapy and Psychosomatics 89, 17–24.CrossRefGoogle ScholarPubMed
Rosenthal, N, Sack, DA, Gillin, J, Lewy, A, Goodwin, F, Davenport, Y, Mueller, PS, Newsome, DA and Wehr, T (1984) Seasonal affective disorder. A description of the syndrome and preliminary findings with light therapy. Archives of General Psychiatry 41, 72–80.CrossRefGoogle ScholarPubMed
Sit, DK, McGowan, J, Wiltrout, C, Diler, RS, Dills, J, Luther, J, Yang, A, Ciolino, JD, Seltman, H, Wisniewski, SR, Terman, M and Wisner, KL (2018) Adjunctive bright light therapy for bipolar depression: a randomized double-blind placebo-controlled trial. American Journal of Psychiatry 175, 131–139.CrossRefGoogle ScholarPubMed
Sui, GY, Liu, GC, Liu, GY, Gao, YY, Deng, Y, Wang, WY, Tong, SH and Wang, L (2013) Is sunlight exposure a risk factor for age-related macular degeneration? A systematic review and meta-analysis. British Journal of Ophthalmology, 97(4), 389–394.CrossRefGoogle ScholarPubMed
Tamura, N, Sasai-Sakuma, T, Morita, Y, Okawa, M, Inoue, S and Inoue, Y (2016) A nationwide cross-sectional survey of sleep-related problems in Japanese visually impaired patients: prevalence and association with health-related quality of life. Journal of Clinical Sleep Medicine 12, 1659–1667.CrossRefGoogle ScholarPubMed
Tao, L, Jiang, R, Zhang, K, Qian, Z, Chen, P, Lv, Y and Yao, Y (2020). Light therapy in non-seasonal depression: an update meta-analysis. Psychiatry Research 291. doi: 10.1016/j.psychres.2020.113247.CrossRefGoogle ScholarPubMed
Terman, M, Terman, JS, Quitkin, FM, McGrath, PJ, Stewart, JW and Rafferty, B (1989) Light therapy for seasonal affective disorder. A review of efficacy. Neuropsychopharmacology 2(1), 1–22.CrossRefGoogle Scholar
Topp, CW, Østergaard, SD, Søndergaard, S and Bech, P (2015) The WHO-5 well-being index: A systematic review of the literature. Psychotherapy and Psychosomatics 84(3), 167–176.CrossRefGoogle ScholarPubMed
WHO (2010) ICD10. International Statistical Classification of Diseases and Related Health Problems.Google Scholar
Williams, J, Link, M, Rosenthal, NE, Amira, L and Terman, M (1992) Structured Interview Guide for the Hamilton Depression Rating Scale – Seasonal Affective Disorder version (SIGH-SAD). New York, NY: New York State Psychiatric Institute.Google Scholar